Organization
Medical Addiction Treatment Clinic
Provider's NPPES record last updated: August 17, 2022
Overview
- Entity Type
- Organization
- NPI
- 1891031209
- Primary Specialty
- Internal Medicine — Addiction Medicine
- Practice Location
- Minneapolis, Minnesota
- Organization Subpart
- No
Federal Screening
NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.
List of Excluded Individuals/Entities (LEIE)
HHS Office of Inspector General
No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.
- Source data
- September 10, 2026
- Records indexed
- 84,001
- Screened
- Sep 18, 2026, 7:27 AM UTC
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
SAM.gov Exclusions
U.S. General Services Administration
SAM.gov Exclusions was not checked.
SAM.gov screening is not configured on this deployment. No SAM check has been performed.
- Screened
- Not checked
This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.
This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.
Searches OIG LEIE and SAM.gov by name and reviews every potential match.
Specialties & Taxonomies
- Primary
Internal Medicine
Addiction Medicine
Allopathic & Osteopathic Physicians
An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.
Taxonomy code 207RA0401X Clinic/Center
Ambulatory Health Care Facilities
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Taxonomy code 261Q00000XPhysician Assistant
Medical
Physician Assistants & Advanced Practice Nursing Providers
Definition to come...
Taxonomy code 363AM0700XNurse Practitioner
Psychiatric/Mental Health
Physician Assistants & Advanced Practice Nursing Providers
Definition to come...
Taxonomy code 363LP0808X
Provider-Reported License Information
- Internal Medicine (Minnesota)
- 52519
- Physician Assistant (Minnesota)
- 12684
Practice Locations
Practice Location
3805 Washington Ave N
Minneapolis, Minnesota 55412-2141
Phone: (612) 887-6282
Other Names
- Sage PrairieReported July 5, 2018
Record Information
- Enumeration Date
- December 13, 2012
- Provider's NPPES Record Last Updated
- August 17, 2022
- Certification Date
- August 17, 2022
- NPISignal NPPES Dataset
- August 2026
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